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Improve Access to Prescription Drugs in Urban Areas

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Message Douglas Hoey
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Big city life affords experiences and opportunities unattainable elsewhere but comes with unique challenges as well.Access to prescription drugs and pharmacy services is among those challenges, according to newly published research that illustrates the need for practical solutions, particularly for seniors.

When people stick to their medication their health outcomes are better and overall costs go down. Expensive hospitalizations and other interventions are reduced or avoided. As much as $290 billion is spent due to the improper use of medication, according to the Network for Excellence in Health Innovation (NEHI). Convenient access to a pharmacy, of course, is a prerequisite.

In some urban areas, that's no guarantee. Health Affairs recently published a study entitled "'Pharmacy Deserts' Are Prevalent In Chicago's Predominantly Minority Communities, Raising Medication Access Concerns." The study scrutinized pharmacy and patient access data in Chicago from 2000 and 2012.

Approximately one-third of the city's 802 communities were "pharmacy deserts," meaning their residents met the researchers' criteria for low pharmacy access. Over half of the pharmacy deserts were in communities where the population was more than 50 percent black.

Moreover, the pharmacy access disparity in these areas is worsening. While the number of pharmacies (particularly national chain pharmacies) in majority-white communities increased 20 percent during the years examined, there was no such expansion in minority communities. Patients in other major U.S. cities likely face similar problems.

Locally owned community pharmacies comprised a 20 percent higher share of the pharmacies serving majority-black communities, compared to the Chicago population as a whole. The findings argue for policies to encourage more pharmacies of all types to locate in these areas.

For seniors, this access problem is magnified. Many Medicare beneficiaries are enrolled in prescription drug plans that lure them to enroll with attractive, low copays. These discounts, unfortunately, are only available to the patient at a limited number of "preferred" pharmacies designated by the plan.

Urban Medicare Part D patients have much greater difficulty actually accessing those discounts in comparison to their suburban and rural counterparts, according to a study released by the Centers for Medicare and Medicaid Services (CMS). More than half of these drug plans (54 percent) failed to meet the government's threshold for reasonable access to pharmacies, in this case those authorized to offer "preferred" copay discounts.

Worse, insurance middlemen known as pharmacy benefit managers typically won't expand patients' access to the medication copay discounts by allowing the more convenient, but excluded independent community pharmacies to sign up as a "preferred" pharmacy. Thus, patients may unwittingly enroll then learn they must make substantial trips to take advantage of the advertised prices. This can especially be a burden for homebound seniors and those with limited mobility or transportation access who may rely on same-day, home delivery from their independent community pharmacy.

Fortunately, there is an easy, no-cost solution to mitigate this problem for seniors. Congress should enact legislation that would allow "any willing provider" in a medically underserved area to participate as a "preferred" pharmacy, so long as it agrees to the drug plan's terms and conditions. Bipartisan legislation to do this has been recently introduced -- H.R. 793, the Ensuring Seniors Access to Local Pharmacies Act.

Encouraging more pharmacies in underserved areas, while achievable, is complex and relies on many factors. However, we can take an important step today toward greater prescription drug access for seniors in these communities. Let's broaden those limited pharmacy networks for those most in need.

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B. Douglas Hoey, RPh, MBA Hoey is the Chief Executive Officer of the National Community Pharmacists Association. He has spent 20+ years working in and representing community pharmacies. NCPA represents the 23,000 community pharmacies and (more...)

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